Health Care Reform and Psychiatry

I recently came across an APA article titled Change, Challenge, and Opportunity: Psychiatry in the Age of Health Care Reform.  It was co-authored by Jeffrey Lieberman, MD, and Howard Goldman, MD, PhD, and dated October 3.

The article discusses the implications of the Affordable Care Act (Obamacare) for psychiatry, and also reviews progress of the 2008 Mental Health Parity Act.  The latter mandated that insurance coverage for “mental illnesses” be essentially on a par with coverage for general medical problems, but the act has not yet been implemented in its entirety.  The authors also point out that there are provisions in the ACA that focus on reform of the actual health care services, as well as the reform of health care insurance.

The article notes that the implementation of the various stages of these pieces of legislation may “…create an increase in the demand for psychiatric services and more resources to help pay for them.”

The authors go on to say that in anticipation of the ACA and the full implementation of the Parity act, the “APA has geared up to prepare and protect psychiatry and mental health care and ensure the best outcome for our patients.” [emphasis added]

In this regard, they have created a work group on health care reform chaired by Howard Goldman.  This work group, whose mission is to ensure that the health care reform process “…produces the best outcomes for psychiatrists, mental health care providers, and most importantly, our patients,” [emphasis added] has retained the following outside consultants:

  • Michael Hogan, PhD, former commissioner of mental health in Connecticut, Ohio, and New York.  Dr. Hogan is reportedly a supporter of universal mental health screening.  In his testimony to a Senate Committee earlier this year, he advocated that a mental health practitioner be stationed in every primary care setting so that it would be possible to “…screen for mental health problems, measure progress, allow billing for basic mental health services like educating patients about managing their depression and ensure a psychiatrist or other specialist is available for consultation.”
  • Sherry Glied (dean of the New York University Wagner School of Public Health and former assistant secretary for planning and evaluation in the Department of Health and Human Services in the Obama administration)
  • Tom McGuire (a professor of health economics at Harvard Medical School)
  • David Satcher (former U.S. surgeon general)

The APA has also retained former US legislator Patrick Kennedy as “…a consultant and spokesperson on mental health policy and legislation.”  Patrick Kennedy is a staunch supporter of the Mental Health Parity Act.

The work group and its consultants, we are told, “…work hand in glove with the staff of the APA’s Division of Advocacy…”  In addition, APA has retained the services of a communications company to work with “…the Office of Communications and Public Affairs to develop a communications strategy on HCR topics aimed at our members and stakeholder groups.”

So – the gist of all this is that the APA is preparing for health care reform.

In recent years the psychiatric profession has received a great deal of criticism.  We’ve had the ghost-writing scandals, the decades-long corrupt relationships with pharma, the fraudulent research, the pharma infomercials posing as continuing education, the pharmaceutical contamination of the DSM, Thomas Insel (Director of NIMH) backing off DSM, the so-called Key Opinion Leaders, the fabrication of childhood bipolar disorder, the prescribing of neuroleptic drugs to infants for temper tantrums, etc., etc…  In addition, we’ve seen literally thousands of psychiatric survivors speak out bluntly and convincingly about the destructive and disempowering “treatment” they received at the hands of psychiatry.  The facile and spurious concepts that have driven the profession for decades are crumbling under persistent, evidence-driven scrutiny.  And – perhaps most immediately troubling – the likelihood that psychiatric drugs are a significant causative factor in the mass shootings is receiving increasing attention, despite pharma-psychiatry’s concerted attempts to spin this matter and to deflect attention.

So psychiatry certainly has a great deal of reforming to do, and one might have imagined that the work force and the Office of Communications and the various eminent consultants would be figuring how psychiatrists might formulate an apology to the people they have injured, retract the misinformation they’ve disseminated, and begin the process of mending their ways.  Alas, no.

Most of the work force documents are behind a lock-wall, but I did find one interesting document.  It’s written under the APA masthead and appears to be an “about” page on the APA’s Council on Communications.  The current council members are listed.  The chairperson is Jeffrey A. Borenstein, MD, who, according to Dollars for Docs, received $555,018 from Pfizer in 2010-2011 for research.

The page opens with a brief statement of what the Council does.  Then it says this (and I’m not making this up):

“The council is charged with transforming public attitudes towards psychiatry by:

    • Connecting the public emotionally to psychiatrists, ·
    • Creating excitement about psychiatrists’ ability to prevent and treat mental illness, and
    • Branding psychiatrists as the mental health and physician specialists with the most knowledge, training, and experience in the field.”

So they’re not going to come clean about the damage they have done; they’re not going to apologize; and they’re certainly not going to mend their ways.  But they are going to connect the public emotionally to psychiatrists.  They’re going to create excitement about their skills and abilities.  And they’re going to “brand” themselves as the mental health grand masters.  What planet do these people live on?  Can you imagine cardiologists or nephrologists or rheumatologists coming up with drivel like this?

These are adult people, sitting in committees, bringing their collective wisdom to bear on these important topics.  And their best ideas are that they need to connect the public emotionally to psychiatrists, get us excited about their abilities, and “brand” themselves as the most knowledgeable people in the field.  Note, they don’t say that they’re going to become the most knowledgeable people in the field – they’re just going to brand themselves as the most knowledgeable.  This is like putting a new label on a can of beans!

I’m visualizing our good friend Dr. Lieberman (dressed like Mick Jagger and wearing a Bob Dylan mask) addressing a million people in the mall.

“We can make you happy!”  Rah! Rah!
“We will have drugs for everybody!”  Rah! Rah!
“We can make all your problems go away!”  Rah!  Rah!
“We are the champions!”  Rah!  Rah!
“Oh happy day!”  Rah!  Rah!  We love you Jeffrey!

Enough.

Sometimes I think that those of us who critique psychiatry could just take a long vacation.  They’re doing our work for us.

The APA has never grasped the fundamental truth that a profession stands or falls on the validity of its concepts, and the efficacy and success of its activities.  In the early days of railroad construction, bridges frequently collapsed under the weight of the trains.  Imagine if this were still the case today, and bridge engineers, instead of developing better concepts and better techniques, decided that they needed to forge emotional bonds between themselves and public, and to generate public excitement about their skills and abilities.   And yet, somehow, psychiatrists, who have done far more damage than the bridge designers of the early 1800’s, imagine that they can simply shrug this off with a tawdry PR job.

Psychiatry is a great disrespector of people.